Hypertension and cardiometabolic disorders appear 5-10 years earlier in women with pre-eclampsia.

Objective: Despite increased cardiovascular (CV) disease risks after pre-eclampsia, guidelines remain indefinite on the necessity, timing, and frequency of CV risk assessment in these women. We aimed to provide prevalence-based recommendations on systematic follow-up after pre-eclampsia by evaluating the age-related prevalence of CV risk factors in former pre-eclamptic women compared to women with a history of normotensive gestation.

Results: A retrospective cohort study was performed amongst parous women, up to 30 years postpartum. Prevalence of CV risk constituents was assessed based on standardized clinical measurements and medical history, including hypertension, diabetes mellitus, hypercholesterolaemia, obesity, insulin resistance, chronic kidney disease, and micro-albuminuria We included 1040 women after pre-eclampsia and 518 normotensive gestated controls. Higher development rates of either/combined hypertension, diabetes mellitus, or hypercholesterolaemia were observed after pre-eclampsia than normotensive gestation (aHR 2.6 (95% CI 2.1-3.2)). These factors occurred on average 8 years earlier after pre-eclampsia (39 ± 9 years) than normotensive gestation (47 ± 8 years). With ageing, hypertension prevalence increased more steeply after pre-eclampsia (P-value interaction = 0.044). Cumulative proportion of hypertension exceeded the 10% cut-off for CV risk assessment initiation from 35 years onwards in women after pre-eclampsia, with an increase above the 5% cut-off for re-assessment every five years.

Conclusions: Cardiovascular risk factors occur almost a decade earlier in former pre-eclamptic women compared to women after normotensive gestation, predominantly, but not exclusively, due to the early and accelerated development of hypertension. Systematic CV risk (re-)assessment is recommended at least five yearly in former pre-eclamptic women from 35 years of age onwards.